Starting Insulin

I got a call the other day from a good friend with type 2 diabetes. He had been told he was no longer responding adequately to his oral diabetes medications and would have to start insulin. Knowing that I have type 1 diabetes and have used insulin for years, he wanted to ask me about my experience.

My friend was quite upset and even fearful. Surprisingly, it wasn't the prospect of taking shots that was the problem. For him, going on insulin meant several very dark and negative things: that this change was his fault, that he was personally responsible for failing to control his diabetes well, and that he had let down his family. What frightened him the most was the belief that going on insulin was going to do his body harm and was tantamount to a death sentence.

I've learned (and research confirms) that many people with type 2 have similar thoughts about going on insulin. But why? This comes, in part, from a lack of understanding of the physiology of type 2 diabetes. In most people who have type 2 long enough, the beta cells, which make insulin, will in essence become fatigued and stop functioning their best. They won't respond as well as they once did to oral meds designed to stimulate insulin production, and they'll need the help of injected insulin. The need for insulin reflects not a personal failing but the natural course of the disease. Sadly, the notion of personal failure may also stem from how some physicians use the prospect of insulin injections as a threat, instead of as a viable treatment option, to spur their patients to take their oral medications faithfully.

In addition, many patients are long allowed to have poorer blood glucose control than is recommended before beginning insulin. So, for many type 2 patients, insulin represents the "last option" for gaining control after various oral medications have been tried and failed. When we see our friends with type 2 begin to use insulin, they sometimes already have serious, even end-stage complications of diabetes that are no longer reversible. Many people believe insulin is the cause of these complications. But, of course, insulin didn't cause these problems at all; poor glucose control did.

So, how should you regard insulin if you have type 2 diabetes? Well, of all the treatment options currently available, insulin is the one with which we have the most experience (over 80 years), the least artificial (the human body naturally makes and needs insulin), and often the most potent. It is one of several available medications, not a treatment of last resort. If you have type 2, I suggest that you discuss with your doctor whether insulin is a good choice for you now. Don't wait until you have run out of options.